#SeeTheMusic and More – Presbyopia and performing arts professionals

Presbyopia and the performing arts professional

In our unique position as the UK’s only eye care specialists working with performing arts professionals, we are well aware of how eye disorders and refractive errors can negatively impact careers. As BAPAM registered practitioners we are using this series of blogs to highlight and explain many common eye conditions that performers face. The performing arts professionals that we have helped include musicians and presenters, dancers and camera operators, sound technicians and singers.

The four most common types of refractive error are:

  • Myopia or Short-sightedness. Myopia results from light focusing just short of the retina due to the cornea or the eyeball being too long.
  • Hyperopia or Long-sightedness. Generally, hyperopia is a result of the eyeball being too short from front to back, or of problems with the shape of the cornea (the top clear layer of the eye) or lens (the part of the eye that helps the eye to focus).
  • Presbyopia or Old Sight. Presbyopia is caused by a hardening of the eyes crystalline lens, which occurs with ageing. As our lenses become less flexible, they can no longer change shape to focus on close-up images.
  • Astigmatism, or rugby ball-shaped eyes. Astigmatism causes blurred distance and near vision due to a curvature abnormality in the eye. A person with astigmatism either has an irregular corneal surface or a lens inside the eye that has mismatched curves. 

In the UK, 61 percent of people have vision problems that require corrective action. Just over 10 percent of people regularly wear contact lenses, and more than half wear glasses. However, not all vision problems are caused by refractive error. In spite of the name, presbyopia is not caused by refractive error, but rather by the hardening of the crystalline lens of the eye as we age. The lenses become less flexible as they age, so they cannot focus on close-up objects.

There are several symptoms associated with presbyopia, including blurry vision, headaches, and difficulty focusing on objects up close. Vision continues to deteriorate as we age. 

Presbyopia and the musician

Presbyopia affects performing arts professionals slowly over time and may present some with career-limiting consequences A performer with presbyopia has difficulty seeing objects that are close to them clearly, from around the age of 50 this includes the music on the stand. Often objects at a distance remain relatively clear unless the presbyopia is combined with another eye condition or refractive error.  The numerous working distances present a variety of challenges to the performer. The need to see the music on the stand is often the biggest issue. Even so, seeing the conductor, the audience, the soloist, and other sections of the ensemble clearly can pose a challenge. 

What causes presbyopia?

As we age, the lens of our eyes becomes less flexible and we have difficulty focusing on close-up objects. Imagine the eye as a camera. Whether an object is near or far, the lens of the camera can autofocus on it. Our eyes work in a similar way. The iris works with our corneas to focus light. Our curved corneas bend light, and then a tiny circular muscle encircling our crystalline lenses contract or relax, causing a change of focus. The muscle relaxes if the object is far away. When something is close, the muscle contracts, allowing us to focus on nearby items such as a book, computer screen, mobile phone or sheet music. However, as we age, our eyes continue to grow and add layers of cells to the lens – a bit like an onion! As a result, the lens becomes thicker and less flexible. Nearby objects are blurred as a result.

#SeeTheMusic and more

The visual demands of performing artists and those who work in production are extremely diverse. Thus, presbyopia can pose some serious challenges. Musicians and presenters must contend with music on the stand or an autocue for the presenter. In the production control room, the production team views multiple screens on a wall of video monitors. The team typically reviews scripts, running orders, production notes and often musical scores as well. Focusing at multiple distances can be challenging in a fast-paced environment such as this.

Musicians and performers often ask us, as performing arts eye care specialists, “What makes their eyes so unique?” Performers’ vision or their eyes aren’t particularly exceptional, but the way they use them is. Artists share many characteristics with athletes when it comes to the many visual demands they are subjected to.

The vision skills required for all sports, both competitive and non-competitive, differ depending on the sport. The same is true for most performers, whether they are professionals or amateurs, what instrument they play and the ensemble they play in. Their role as a performing arts professional presents different challenges, from sound technicians, camera operators, production staff and lighting engineers, they all have multiple viewing distances and visual demands.

Allegro Optical has developed detailed assessments of vision skills for artists and performers of all ages using advanced diagnostic equipment and investigative techniques.

Most performing arts professionals need one or more of the following skills:

  • Vision focusing:

    A capability to change focus quickly and precisely between objects of different distances. Musicians must be able to read the music on the stand, look at their conductor, and see other sections of the ensemble clearly and accurately from different distances.

  • Vision fixation:

    Music reading skills, particularly at a fast tempo and regardless of how fast the music moves.

  • Peripheral vision:

    Observing an object out of the corner of your eye, such as a sheet of music on a stand or a bank of flat or curved screens in a production room. Even when a player is unable to alter their head position due to their instrument, they must still be able to see both their stand partner or another member of their section.

  • Focusing regulation:

    Maintaining eye coordination during high-speed activities or when under high physiological pressure.

Effective treatment of Presbyopia

Spectacles

Presbyopia presents unique challenges for first-time spectacle wearers, such as a reduction in depth of focus when wearing reading glasses. Spectacles used solely to correct presbyopia (reading glasses) have a number of disadvantages, including an enlarged image size or magnification, peripheral distortions, and a reduced field of vision.

All of these present performance-limiting challenges to the performer. As Michael Downes, Director of Music St Andrew’s University said “Things had become more challenging very quickly – until I was 47 or 48 I didn’t have any problems at all, but then they rapidly became severe. The ‘tipping point’ was an April 2019 concert – I realised that unless I did something about it I would no longer be able to carry on doing my job to a satisfactory standard.

Without the help given me by Allegro Optical, I think I would be continuing to have very severe difficulties.”  

Many performing arts professionals turn to varifocals, bifocals or “office” lenses to resolve their vision problems, however all of these lenses present the musician with problems. Even the very best individual designs and “tailor made” varifocal lenses provide a narrow field of clear vision. 

Occupational, “Office” or computer lenses provide a wider field of view, but the depth of field is often limited to 2-4 metres.

Bifocal lenses do offer a limited solution in that the bottom of the lens will magnify the music on the stand and the upper part of the lens provides a clear view of the conductor, however, the wearer does experience two different image sizes. This is known as image jump and it can present problems to some wearers.

Contact lenses

Some performers prefer to use contact lenses, particularly if they find using glasses inconvenient or unattractive.

The lightweight and near-invisible properties of contact lenses make them appealing to performers, but a presbyopic correction can sometimes be less satisfactory if not worn before.  Presbyopic contact lens wearers often complain that they can’t see as well in contact lenses and that their distance vision is compromised.  In addition to a long-wear period and a dry, warm and often dusty environment, wearing contact lenses on stage can also exacerbate dry eyes. Most contact lens wearers experience dry eye symptoms toward the end of the day. Unfortunately, the majority of musicians perform in the evening, so this often coincides with their performances. For musicians, especially those who work as freelancers or session musicians, dry eyes can lead to blurred patches of vision that make sight-reading difficult.

Laser eye surgery

Laser eye surgery is often considered as a way around having to use glasses and contact lenses, we would add a word of caution here for performing arts professionals. We see many clients who come to us a few years after having undergone laser surgery. Most complain that while they can still see well in the distance and for reading, their music reading distance is deteriorating, especially if they have opted for a monovision correction. When performers ask us about laser surgery we usually recommend lens replacement surgery. 

Lens implant surgery

Lens implants are a viable and long-term treatment for presbyopia. A small incision is made in the cornea to implant an artificial multifocal lens into your eye to focus light more clearly onto the retina for all distances.

Also known as Refractive lens exchange (RLE) is an operation similar to cataract surgery in which the natural lens is removed and replaced with an artificial one.

The procedure is typically done under local anaesthesia, and you can normally go home the same day. The procedure is usually done separately for each eye.

In Summary

Both performers and amateurs find many of the optical corrections discussed above to be a viable solution to the problems posed by presbyopia. Some however find the plethora of solutions available on the high street to be far from ideal. 

As performers ourselves our unique perspective enables us to offer balanced, impartial advice, it also allows us to create unique lens designs and optical solutions to correct the vision disturbance presented by presbyopia. 

Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them. 

With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians and their access to cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve hyperopic performing arts practitioners vision problems.

Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/

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